Freaking Out Over FINALS? You’re Not Alone!

Intense test anxiety affects up to 20% of college students, and this time of year is the WORST. Finals are approaching, projects and papers are due, and added pressure from mistakes earlier in the semester can push students over the edge. Students (and their parents) often question whether they feel different than everyone else- is this “normal” or should they seek help?

With a typical student, test day adrenaline might cause extra bathroom trips up until the test starts, a racing heart and anxious anticipation, but once she starts answering questions, the physical symptoms subside enough for the student to focus effectively.

The student with intense test anxiety, however, accelerates symptoms rather than settling down as the exam begins. Sweat pours down his neck and slicks his palms, his racing heart tries to leap out of his chest, meanwhile his lips and fingertips tingle and he feels short of breath (from hyperventilation) and his brain sputters or completely blanks out.

What can be done at this point in the semester? Obviously, we can’t fix poor grades from earlier in the semester, but there are definitely behavioral and medicinal tools that my help you survive finals and ultimately greatly reduce or eliminate your test anxiety moving forward. Before medication, consider these steps:

CUT BACK on stimulants: Caffeine (yes, your COFFEE) and JUULing (or any form of nicotine) are working AGAINST you. Yes, they may be keeping you more alert but they are making your body have all the physical symptoms of anxiety (racing heart, tremors, gut irritation) that then “tells” your brain you are anxious even when you are not. Next time you start feeling sleepy while studying, take 2-5 minutes to raise your heart rate (go up and down stairs, do jumping jacks, whatever it takes) instead of reaching for more caffeine.

Breathing exercises– Stop rolling your eyes…breathing exercises REALLY work, and since this is free and simple, start here. Looking at your watch or phone, take one full minute to focus on your breathing before you enter the testing room, and again just before you start the exam. Breathe in for a slow rcount of four and then breathe out for a slow count of ten. Repeat this sequence three or four times till you feel your body relaxing. If you’ve got an Apple Watch, try this with the Breathe app for visual cues.

Cognitive behavioral therapy (CBT)-either individual or group –is highly effective in treating social phobias such as test anxiety. This “talk therapy” helps people recognize how they are unconsciously MAGNIFYING and catastrophizing potential negative outcomes, which triggers the physical anxiety responses. “I’m going to fail and flunk out of school” becomes “I may not do great on this test, but I’ve done well on other assignments.” Many universities have extra group classes for test anxiety CBT- check out what your school offers (look on their website).

Will one CBT session be enough? Believe it or not, even one session helps people recognize harmful thought patterns and begin to reverse negative thinking.

Can ALL students get appointments the last few weeks of the semester? Resources vary, so if you cannot get in this semester, consider free CBT apps like Mind Shift (focused on anxiety in young adults) or SAM (Self-help for Anxiety Management).

Medications:

The most common prescription medication used is actually a blood pressure medication (a beta-blocker called metoprolol) that is used in low doses primarily for the side effect of slowing the heart rate and reducing tremors.

Interestingly, when the physical sensations of racing heart and tremor are stopped, the brain “hears” that the body is not stressed, and frequently this is enough to lower the test anxiety down to an expected, manageable level. This type of medication is not addictive, and in my clinical experience, there are very few side effects. In fact, students often end up only using these pills for a handful of tests, at which point they have broken the negative test anxiety cycle and no longer need the medication.

Other social phobias such as fear of flying may be medically managed with sedatives called benzodiazepines, such as alprazolam (brand name Xanax). Note that these medications are very addictive, often misused, and sedating, so they are NOT a good option for test anxiety.

Untreated test anxiety leads students to a swirling vortex of stomach pains, headaches, insomnia, fatigue, anxiety and depression. Then self-medication with too much caffeine leads to less sleep, more fatigue, more caffeine, more headaches, irritated stomach lining…and worsening test anxiety. BREAK THE CYCLE before you hit your final round of exams this semester!

BOTTOM LINE: Intense test anxiety is a common, real problem that can be dramatically improved with a few interventions. Schedule an appointment today and get help.

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Jill Grimes, MD, is a board-certified family physician with a passion for preventative medicine. She shares her opinions about all things medical, breaking down complex clinical issues into common sense explanations. Her blog is for informational purposes only, and should not be considered medical advice, as you (the reader) hereby agree that there is no physician-patient relationship. Please do, however, use this information to start a discussion with your own health care providers.